This program provides under served, at risk youth an opportunity to participate in the club and its programs. To get started, fill out the application below. Scholarship Application Contact Information First Name * Last Name * Date of Birth * Month 1 2 3 4 5 6 7 8 9 10 11 12 / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972 Street Address * City * Zip / Post Code * Home Phone * Cell Phone E-mail Address * School * Name of Parent or Guardian * Relationship * Please explain in a few sentences why you are requesting a scholarship. * Please tell us why you would like to participate in our program. * Personal References Personal Reference #1 Name * Relationship * Phone Number * Personal Reference #2 Name * Relationship * Phone Number * Submit Scholarship Application